{
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"FirstLineMailingAddress": "1846 1ST ST STE 150",
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"FirstLinePracticeLocationAddress": "15242 HANKS WAY",
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"EnumerationDate": "02/07/2026",
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"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MWEMBO",
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"AuthorizedOfficialTelephoneNumber": "208-519-7545",
"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}